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   2009| July-September  | Volume 19 | Issue 3  
    Online since August 4, 2009

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Ultrasound characterization of breast masses
Sudheer Gokhale
July-September 2009, 19(3):242-247
DOI:10.4103/0971-3026.54878  PMID:19881096
A lump in the breast is a cause of great concern. High frequency, high-resolution USG helps in its evaluation. This is exemplified in women with dense breast tissue where USG is useful in detecting small breast cancers that are not seen on mammography. Several studies in the past have addressed the issue of differentiating benign from malignant lesions in the breast. The American College of Radiology has also brought out a BIRADS-US classification system for categorizing focal breast lesions.
  21,876 3,409 3
Radiological appearances of uterine fibroids
Sue Wilde, Sarah Scott-Barrett
July-September 2009, 19(3):222-231
DOI:10.4103/0971-3026.54887  PMID:19881092
Uterine fibroids, also known as leiomyomas, are the commonest uterine neoplasms. Although benign, they can be associated with significant morbidity and are the commonest indication for hysterectomy. They are often discovered incidentally when performing imaging for other reasons. Usually first identified with USG, they can be further characterized with MRI. They are usually easily recognizable, but degenerate fibroids can have unusual appearances. In this article, we describe the appearances of typical and atypical uterine fibroids, unusual fibroid variants and fibroid mimics on different imaging modalities. Knowledge of the different appearances of fibroids on imaging is important as it enables prompt diagnosis and thereby guides treatment.
  19,285 2,388 9
Imaging features of extraaxial musculoskeletal tuberculosis
Adelard I De Backer, Filip M Vanhoenacker, Darshana A Sanghvi
July-September 2009, 19(3):176-186
DOI:10.4103/0971-3026.54873  PMID:19881081
Tuberculosis (TB) continues to be a public health problem in both developing and industrialized countries. TB can involve pulmonary as well as extrapulmonary sites. The musculoskeletal system is involved in 1-3% of patients with tuberculosis. Although musculoskeletal TB has become uncommon in the Western world, it remains a huge problem in Asia, Africa, and many developing countries. Tuberculous spondylitis is the most common form of musculoskeletal TB and accounts for approximately 50% of cases. Extraspinal musculoskeletal TB shows a predilection for large joints (hip and knee) and para-articular areas; isolated soft tissue TB is extremely rare. Early diagnosis and prompt treatment are mandatory to prevent serious destruction of joints and skeletal deformity. However, due to the nonspecific and often indolent clinical presentation, the diagnosis may be delayed. Radiological assessment is often the first step in the diagnostic workup of patients with musculoskeletal TB and further investigations are decided by the findings on radiography. Both the radiologist and the clinician should be aware of the possibility of this diagnosis. In this manuscript we review the imaging features of extraspinal bone, joint, and soft tissue TB.
  10,814 2,470 29
Impact of ultrasonography on central venous catheter insertion in intensive care
Gopal B Palepu, Juneja Deven, M Subrahmanyam, S Mohan
July-September 2009, 19(3):191-198
DOI:10.4103/0971-3026.54877  PMID:19881083
Background and Aims: The insertion of central venous catheters (CVCs) is an integral part of the management of critically ill patients. We aimed to study the impact of ultrasonography (USG) on CVC insertion in intensive care. Setting and Design: A prospective study of 450 patients requiring CVC in the intensive care unit (ICU) of a tertiary care hospital. Methods and Materials: The patients were randomized into two groups: to have CVC insertion with USG-guidance or with the anatomic landmark technique (ALT). Data were collected on patient demographics; operator experience; and method, site and side of insertion. Outcome measures included successful insertion of CVC, number of attempts needed and complications. Results: Internal jugular vein (IJV) cannulation was successful in 177/194 patients (91.2%) using ALT and in 200/205 patients (97.6%) using USG guidance, a significant difference of 6.4% (P = 0.006). Using ALT, 72.7% of cannulations could be accomplished in the first attempt as compared with 84.4% with USG guidance (P = 0.004). The overall complication rate was 28/399 (7%), with 19 (9.8%) complications in the ALT group and 9 (4.4%) in the USG group (age-, sex-, and operator-adjusted OR = 0.35, 95% CI: 0.13-0.96; P = 0.03). For subclavian vein catheterization, the success rate was 26/28 (92.9%) in the ALT group and 17/17 (100%) in the USG group (P = 0.52). Using ALT, 71.4% cannulation could be accomplished in the first attempt as compared with 82.4% under USG guidance (P = 0.49). The overall complication rate was 6/45 (13.3%), with 4 (14.3%) complications in the ALT group and 2 (11.8%) in the USG group (P > 0.99). Conclusions: Real-time USG guidance improves success rates, reduces the number of attempts and decreases the complications associated with CVC insertion, especially for the IJV, and should become the standard of care in intensive care.
  6,397 885 21
Case report: Upper neck pouch sign in the antenatal diagnosis of esophageal atresia
Mukesh Kumar Garg
July-September 2009, 19(3):252-254
DOI:10.4103/0971-3026.54875  PMID:19881098
Prenatal diagnosis of esophageal atresia remains a challenge for the imaging consultant. On antenatal USG, the finding of an absent or small stomach in the setting of polyhydramnios used to be considered suspicious of esophageal atresia. However, these findings have a low positive predictive value. The upper neck pouch sign is another sign that helps in the antenatal diagnosis of esophageal atresia. In this paper, I report a case of esophageal atresia that was diagnosed on USG at 27 weeks of gestation; the diagnosis was confirmed postnatally.
  4,948 638 -
Role of color doppler in scrotal lesions
Bhardwaj Patiala
July-September 2009, 19(3):187-190
DOI:10.4103/0971-3026.54874  PMID:19881082
Color Doppler USG of the scrotum has been demonstrated to be useful in the diagnosis of scrotal lesions. Gray-scale USG characterizes the lesions as testicular or extratesticular and, with color Doppler and power Doppler, flow and perfusion can also be assessed. Color Doppler is particularly helpful in acute painful conditions, where it can differentiate testicular ischemia from inflammatory conditions and thus prevent unnecessary surgical explorations. With color Doppler, useful information can be gained about vascularity in testicular malignancies. Color Doppler also has high sensitivity and high specificity in the diagnosis of lesions like varicoceles.
  4,296 1,177 1
Double fetus-in-fetu: CT scan diagnosis in an adult
BV Daga, VA Chaudhary, Amit S Ingle, Vinayak B Dhamangaokar, Deepti P Jadhav, Prasanna A Kulkarni
July-September 2009, 19(3):216-218
DOI:10.4103/0971-3026.54890  PMID:19881090
A fetus-in-fetu (FIF) is an uncommon developmental abnormality characterized by a reasonably well-formed but aborted fetus that is seen in the form of an encapsulated, pedunculated vertebrate tumor in the patient's abdomen. We report an interesting case of a double FIF in a 20-year-old man, who presented with acute abdominal pain and a lump. CT scan of the abdomen revealed two ill-formed fetuses-in-fetu, which were seen as a 15-cm complex, encapsulated mass in the lower retroperitoneum; there was also free fluid in the abdomen. The diagnosis of a ruptured twin FIF was made. Complete surgical excision of the lesion was performed and the diagnosis was confirmed histopathologically. To the best of our knowledge, the CT scan findings of a ruptured double FIF in an adult have not been previously documented.
  4,710 634 5
Efficacy and safety of USG-guided ethanol sclerotherapy in cystic thyroid nodules
SR Jayesh, Pankaj Mehta, Mathew P Cherian, V Ilayaraja, Prashanth Gupta, K Venkatesh
July-September 2009, 19(3):199-202
DOI:10.4103/0971-3026.54879  PMID:19881084
Objective : To study the effectiveness and safety of USG-guided ethanol sclerotherapy in cystic thyroid nodules. Materials and Methods : USG of the thyroid gland was performed in 54 patients suspected to have a thyroid nodule on clinical examination. All patients with a predominantly cystic nodule (i.e., when >2/3 rd of the nodule was cystic) were included in the study. Ethanol was injected into the cyst under USG guidance. The amount of ethanol injected was about 50% of the amount of aspirated fluid. Follow-up USG was done every month for 3 months; ethanol was re-injected when there was no significant reduction in the cyst volume. The initial cyst volume was compared with the final volume; statistical significance was assessed using the paired t-test. Results : USG revealed predominant cystic nodules in 16 of the 54 patients. Fifteen patients were selected for the study. Following ethanol sclerotherapy, four out of the 15 patients (26.6%) showed complete disappearance of the cyst and nine (60%) showed significant reduction in the cyst volume (i.e., reduction of cyst volume by ≥50% of initial volume). Only two patients did not show significant reduction in cyst volume; both these patients had nodules with an initial volume of ≥20 cc. There were no complications attributable to ethanol injection during follow-up. Conclusion: Ethanol sclerotherapy is an effective and safe treatment for benign cystic thyroid nodules with volumes of <20 cc. Cystic nodules with volume >20 cc may need more number of alcohol injections and longer follow-up.
  4,632 614 6
Vesicovaginal reflux: A case report
Monali Warade, Yameen Majid, L Dayananda, Kanchan Gupta
July-September 2009, 19(3):235-237
DOI:10.4103/0971-3026.54882  PMID:19881094
Vesicovaginal reflux is a common cause of urinary incontinence in girls. A micturating cystourethrogram, which is the diagnostic investigation of choice, can demonstrate retrograde filling of the vagina during micturition and the complete emptying of the vagina at the end of micturition. Vesicovaginal reflux is a rare cause of gross hydrocolpos occurring without any anatomical obstruction. The condition may be associated with functional voiding disturbances.
  4,478 573 2
Case Report: Littoral cell angioma of spleen
Netra Rana, Zhang Ming, Ma Shao Hui, Yan Bin
July-September 2009, 19(3):210-212
DOI:10.4103/0971-3026.54886  PMID:19881088
Littoral cell angioma is a rare primary vascular neoplasm of the spleen, composed of littoral cells that line the splenic sinuses of the red pulp. It was thought to be a benign, incidental lesion. However, many recent reports have described it to be a malignant lesion with congenital and immunological associations. The definitive diagnosis can only be made after histology and immunohistochemistry studies.
  3,718 446 8
MRI in congenital duplication of urethra
S Bhadury, Umesh C Parashari, Ragini Singh, Neera Kohli
July-September 2009, 19(3):232-234
DOI:10.4103/0971-3026.54884  PMID:19881093
Congenital urethral duplication is a rare anomaly, with less than 200 cases described in the literature. The investigations that are usually performed are micturating cystourethrography (MCU) and retrograde urethrography (RGU), which can diagnose the presence of duplication but cannot diagnose the precise relationship of the duplicated urethra with other pelvic structures. MRI, because of the excellent tissue contrast that it provides and its multiplanar ability, can demonstrate with precision, the size, shape and position of the two urethras. We describe below a case where MRI was able to show this exquisitely.
  3,521 452 6
Magnetic resonance imaging features of myxoid leiomyoma of the vagina: A case report
Michele Scialpi, Giuseppe Benagiano, Sara Frati, Irene Piscioli, Francesco Barberini, Luciano Lupattelli
July-September 2009, 19(3):238-241
DOI:10.4103/0971-3026.54880  PMID:19881095
We report a rare case of a voluminous vaginal myxoid leiomyoma in a 27-year-old nulliparous woman. Magnetic Resonance Imaging (MRI) revealed a mass arising from the vagina, with inhomogeneous signal intensity on spin-echo T1W and T2W images. MRI accurately defined the tissue planes between the lesion and the adjacent structures and suggested its benign nature. The mass was completely resected by means of transvaginal approach and the diagnosis of myxoid leiomyoma was confirmed histologically. To the best of our knowledge, this is the first report describing the MRI features of vaginal myxoid leiomyoma.
  3,185 388 2
Sonological appearance of idiopathic arterial calcification in fetus: A rare case
BR Nagaraj, Prakash Jain, Deepu Alex Thomas, M Raghu
July-September 2009, 19(3):248-251
DOI:10.4103/0971-3026.54876  PMID:19881097
Idiopathic arterial calcification (IAC) is a rare disease characterized by extensive arterial wall calcification. This condition is almost always fatal. A total of 162 cases have been reported to date, with most cases diagnosed postnatally and less than 13 cases having been suspected antenatally. This case report describes a case of IAC detected antenatally with USG at 28 weeks' gestation.
  3,159 407 1
Technical note: CT-guided biopsy of lung masses using an automated guiding apparatus
Amarnath Chellathurai, Saneej Kanhirat, Kabilan Chokkappan, Thiruchendur S Swaminathan, Nadhamuni Kulasekaran
July-September 2009, 19(3):206-207
DOI:10.4103/0971-3026.54883  PMID:19881086
Automated guiding apparatuses for CT-guided biopsies are now available. We report our experience with an indigenous system to guide lung biopsies. This system gave results similar to those with the manual technique. Automated planning also appears to be technically easier, it requires fewer number of needle passes, consumes less time, and requires fewer number of check scans.
  2,936 549 3
PET/CT guidance for percutaneous fine needle aspiration cytology/biopsy
MJ Govindarajan, KR Nagaraj, KG Kallur, PS Sridhar
July-September 2009, 19(3):208-209
DOI:10.4103/0971-3026.54885  PMID:19881087
PET/CT, used as a guiding tool, can improve the accuracy of percutaneous fine needle aspiration cytology (FNAC)/biopsy due to its ability to incorporate both physiological and anatomical information.
  2,915 451 8
Technical note: A simple and effective CO 2 delivery system for angiography using a blood bag
Mathew P Cherian, Pankaj Mehta, Prashant Gupta, Tejas M Kalyanpur, SR Jayesh, R Rupa
July-September 2009, 19(3):203-205
DOI:10.4103/0971-3026.54881  PMID:19881085
Several angiographic techniques have been developed to image the arterial system, the commonest using iodinated contrast media. Useful as they may be, they are not without disadvantages. One other modality is angiography using CO 2 . Although CO 2 can be used as an alternative contrast medium, delivery systems are expensive to procure. We describe an indigenous and effective delivery system developed at our institute.
  2,736 452 -
Imaging of a retained laparotomy towel that migrated into the colon lumen
Umut Ozyer, Fatih Boyvat
July-September 2009, 19(3):219-221
DOI:10.4103/0971-3026.54889  PMID:19881091
Retention of surgical instruments, most commonly small laparotomy sponges, is a known complication of surgery. Such retained instruments may remain silent or may cause a variety of complications. We report a case in which a retained laparotomy towel migrated into the colon. This is an infrequently reported complication. We were able to document the passage of the towel through the colon on plain radiographs. The USG and MRI findings are also described.
  2,758 336 3
Case report: Benign porta hepatic schwannoma
Naveen Kulkarni, Sajan J Andrews, VRK Rao, KV Rajagopal
July-September 2009, 19(3):213-215
DOI:10.4103/0971-3026.54888  PMID:19881089
Schwannoma is a myelin sheath tumor that can occur almost anywhere in the body. The most common locations are the central nervous system, extremities, neck, mediastinum and retroperitoneum. Benign schwannomas in the porta hepatis are extremely rare and radiologically are diagnosed as either enlarged lymph nodes or bowel masses, such as gastrointestinal stromal tumors. In this location they usually produce symptoms by compressing adjacent structures and often present with obstructive jaundice. The preoperative diagnosis can be extremely difficult.
  2,663 368 3
Interventions and turfs
Bhavin Jankharia
July-September 2009, 19(3):175-175
DOI:10.4103/0971-3026.54872  PMID:19881080
  2,377 472 -
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